Urgent & Acute CareTransformation Theme

13th July 2015

Prof Mark Radford Chief Nursing Officer, University Hospitals Coventry and Warwickshire NHS Trust

Matt Aiello Special Projects Manager,Health Education West Midlands

www.hee.nhs.ukwww.wm.hee.nhs.uk

Purpose of today’s session

Exploring the meaning of “Transformation” in an Urgent and Acute Context…

What are your workforce demands in Urgent and Acute Care / EM locally?

How can the transformation theme help shape and support local workforce development?

• Scoping relevant projects, good practice and future initiatives.• Identify top priorities for Transformation Theme development.

Introduction to the Urgent & Acute Care Transformation Theme…

• What is the basis for needing an Urgent & Acute / EM Transformation Theme?• What is our evidence base? Can we demonstrate success? • What are we doing and why?

Workshop

Presentation

Time for a change?

Royal College of Emergency Medicine:

Up to 500 patients died in 2014 as a direct result of EDs becoming overcrowded and almost 350 of the deaths were among patients who had not been diagnosed or given medical treatment quickly enough.

House of Commons Emergency Admissions to Hospital Forty-Sixth Report (2013-14):

The health sector does not consistently work together in a cohesive way to secure savings, better value and a better service for patients.

CQC State of Care report (2013-14):

More than half a million people aged 65 and over are admitted as an emergency with ‘avoidable’ conditions that potentially could have been managed, treated or prevented in the community.

Why do we need to transform?

“The health service needs to change over the next five years if it is to improve quality of care and the health of the population.”

Health Education England… supporting change

HEE 15 Year Strategic Framework: “Levers” to support change:

• Workforce planning• Attracting and recruiting the right people into

training• HEE Corporate enablers to support the above• Using commissioning levers to best effect• Encouraging employers to invest in their people

• Backing diverse solutions and local leadership

• Create aligned national NHS Leadership• Supporting the modern workforce• Exploiting the information revolution• Accelerating useful health innovation• Driving efficiency and productive investment

How can a Transformation Theme support system change?

Overcoming traditional divides

Communication

• …Between primary, community and secondary care…strategic, cultural and attitudinal…

• Talking… to stakeholders and user groups; encouraging cross-organisation, cross-geography

engagement.

• Use innovative new models to break through organisational and traditional boundaries.

• Demonstrate through pilot work, new ways of working… avoid “its not grown here” attitudes by

scaling local projects….

• Multi-Specialty Community Providers / Urgent and Emergency Care Networks – “right care at the

right time in the right place.”

• Creation / identification of relevant networks and key decision makers

• A Joined-up, system wide approach… Avoid replication of work-streams by sharing learning across LETC areas… encourage collaborative working.

• Understand and respond to the needs of local workforces, by engaging the workforces more directly / appropriately.

• “One HEE” – address “silo” working; support cross-LETC working; promote shared learning;

…The transformation theme can provide a regional basis for national project scaling.

Examples of local transformation projects?

…Changing the world, one project at a time…

How do we know it will work?Example Evidence Base: The EM Taskforce

• Department of Health officials and members of the Royal College of Emergency Medicine established the Emergency Medicine Taskforce in September 2011.

• AIM: To address national workforce challenges in Emergency Medicine at local level.

• The West Midlands EM Taskforce first met in January 2013…a region-wide approach.

• Group membership included a cross-section of West Midlands decision makers.

• Developed and delivered a successful portfolio of strategies, to address regional EM and Urgent / Acute workforce challenges.

• Projects take into account both EM / Urgent and Acute Workforce and ED Avoidance measures.

“In order to achieve an understanding of how different health care services can work collectively, new models of training are needed to prepare healthcare professionals for a career in a more joined-up workforce, with the knowledge and skills that span the management of acute health needs across

community and secondary care environments.”

Physician Associate: Supporting training across three West Midlands course providers, from September 2014.

• Developing a Midlands and East PA Steering Group from August 2015.• Supporting cross-LETB development of local funding models.• Educating, informing and understanding more about issues / blockers / concerns surrounding the role, through: events, 1:1

meetings with potential / current employers, development of online learning resources.• Working with Royal College of Physicians (RCP) to launch national RCP PA Faculty from July 2015.

SAS Doctors: A 12 month portfolio of practical EM “shopfloor” skills training launched from December 2013.

• 90 Doctors trained / in training during 2014-15 programme.• Planning underway to launch an EM SAS Fellowship programme, aligned to CESR pathway, from 2016.

Post-CCT GP Fellowship in Urgent and Acute Care: Pilot from January 2014 – November 2015. 7 GPs Trained.

• 1st West Midlands cohort from September 2015. • 1st pilot phase evaluation demonstrated success of concept and justified continuation.• Programme scaled across three London LETBs and KSS from September 2015.

West Midlands ED Pharmacy Project: Results demonstrate potential for clinical pharmacists in the ED.

• HEWM led (scaled up) national ED Pharmacy project, involving 53 Trust EDs in 12 out of 13 LETBs nationally, from March 2015. Evaluation results due October 2015.

Clinically Enhanced Non-Medical Prescribing for Pharmacists (Linked to ED pharmacy projects). • Aim to up-skill Pharmacists to Independent Prescriber level and provide additional clinical skills training in diagnosis / minor

injuries / minor illness. • 2 Phase Pilot: Phase 1 from April 2014 – Feb 2015. Phase 2 from March – September 2015. • 107 pharmacists trained or in training during the pilot.• Endorsed by RPS and GPhC• Scaled cross-LETB

Multi-Disciplinary workforce development: • Delivery of a regional, multi-disciplinary, Advanced Practice training programme pilot; concluding July 2015.• Results demonstrate viability and value of a single course, to train a multi-disciplinary cohort.

Progress of Urgent & Acute / EM Transformation Projects:

2015: Jeremy Hunt: A “New Deal” for General Practice “…Building on the success of a Health Education England pilot in the West Midlands, we will incentivise a number of newly qualified GPs with an extra year of training and support to develop specific skills needed in areas such as paediatrics, mental health and emergency medicine…”

The HEWM Post-CCT GP Fellowship in Urgent and Acute Care (2014 – Present)

Was the EM Taskforce approach a Success?

HEWM Clinically Enhanced NMP for Pharmacists (2014 – Present)

HEWM and HEE ED Pharmacy Projects (West Midlands and National, 2014-15)

Regional and national Physician Associate Development

2015: Royal Pharmaceutical Society (RPS):

“The RPS believes that pharmacists could make a significant impact on patient care by adding both capacity and capability to Emergency Departments...We are fully supportive of the work being undertaken by Health Education England to further evidence the value of pharmacists within Emergency Departments and will be doing everything we can to support those taking part.”

 2015: General Pharmaceutical Council (GPhC):

“The GPhC deemed the project to be a worthy and valuable step in providing high quality care for patients seeking emergency assistance in the West Midlands...We fully support this initiative …was received with great enthusiasm by the delegates representing both pharmacists and nurse NMP programmes. The outcomes of further work with this valuable project will provide the GPhC with vital evidence, as we develop NMP programmes in the future and guidance for pharmacist independent prescribers.”

2015: General Medical Council (GMC): We warmly welcome the launch of the new faculty to support this exciting development. Physician associates look set to play an increasingly important role in supporting the delivery of safe medical care and we are clear that in the interests of patient safety and to maximise their value, they should be subject to statutory regulation…if the four Governments within the UK felt we should do so, we would of course seriously consider that option.  

Transformation Theme Approach

The Transformational Theme will set the strategic vision on large scale transformational change, to ensure the very best patient care

across the West Midlands.

The transformational themes will operate as a separate entity to LETC, but will be driven by

service needs and workforce priorities as identified from the workforce planning process.

Transformation theme will cover the West Midlands health, social care, education and Private Independent and Voluntary sectors.

Each transformation theme will be led by a Steering Group, which will be a decision making group responsible for the overall

direction, assurance and management of the programme.

The stakeholder representatives will be decision makers in senior leadership positions

who understand the strategic agenda to facilitate delivery of the objectives of the

transformational theme as well as provide a critical role in confirm and challenge.

The LETC lead will be responsible for overseeing delivery of the project, contracts

and delivery.

The LETB will provide leadership and direction, scrutiny and oversight across all transformational themes. LETB will agree

funding and outputs for adoption and spread.

Led by a HEWM Board member as an Executive Sponsor

Transformation Themes should support:

• Development of multi-disciplinary training pathways to encourage a joined-up approach across community, primary and secondary care

• Proposing and supporting the introduction of new medical and non-medical roles, to complement the multi-professional workforce.

• Identifying and retaining workforce leaders, to assist in proposing and progressing workforce change

• Creating and maintaining effective communication networks to break through traditional cultural and geographical boundaries and allow for effective shared learning.

• Breaking new ground in training and career development pathways, through innovative pilot and test-of-concept projects

So…What do you think?

Summary

Workshop Sessions

15 Minutes for Table Discussion:

• Nominate a scribe for your table.• Write down your comments and suggestions on the forms provided.• Agree top three “headline” responses on A3 sheet provided.

10 minutes for delegate feedback:

• Each table to nominate a speaker.• Speaker to read out top three headlines agreed by their table.• All comments are important to us and WILL be collected and used to influence / shape the

theme.• Please focus your discussions and responses on workforce transformation.

Your chance to influence the Transformation Theme

“Parking Bay”

For issues outside of the discussion / not relating to workforce transformation, but which are relevant to

HEWM Urgent and Acute / Emergency Medicine work, please contact:

matthew.aiello@wm.hee.nhs.uk

Discussion Topic 1:

• Consider primary, community and secondary care.

• Consider potential for Transformation projects to positively impact on current and future workforce

challenges.

What are the key local issues, challenges and blockers which can and will affect Urgent and Acute / EM workforces?

Showcase Lunch!

• Take some time to watch the Health Education West Midlands documentary: “A Day in the Life of a Physician Associate.”

• Please also feel free to have a look at Posters which have been presented in 2015 around ongoing Urgent and Acute / EM project work.

• The team will be on hand to answer your questions.

• The workshop discussions will continue in 20 minutes…

Please take 20 minutes to have some lunch

Discussion Topic 2:

1. How can the Urgent and Acute / EM Transformation Theme assist in addressing the challenges and supporting the drivers that you have raised?

This a two-part question, so 3 headlines for each question please!

• Consider how the theme can assist you in developing your individual local workforce transformation solutions

• Consider how the theme can assist you in developing joined-up workforce transformation solutions within your local networks.

• Consider how the theme can assist local stakeholders in scaling transformation projects regionally / geographically / nationally and raising awareness of the same.

• Who should the theme be engaging with as Theme board? Eg. Steering Groups; Communication Networks (to disseminate information / request consultation / feedback proposals etc)

2. Communication: Who should the Transformation theme be engaging with, to ensure robust communication and programme delivery?

Key Messages?

Thank you for your time and input.

Theme Contacts

LETB Executive Sponsor / Chair: Andy Hardy,

Chief Executive Officer, University Hospitals Coventry and Warwickshire

LETB Theme Lead: Jane Emson: jane.emson@wm.hee.nhs.uk

Workforce Specialist:Matt Aiello: Matthew.aiello@wm.hee.nhs.uk

Project Manager: Nisha Selopal: nisha.selopal@wm.hee.nhs.uk